Shen De-Song, Yan Chang, Liang Yu, Chen Kai-Hua, Zhu Xiao-Dong
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, People's Republic of China.
Department of Oncology, Wuming Hospital of Guangxi Medical University, Nanning, Guangxi, 530199, People's Republic of China.
Cancer Manag Res. 2021 Oct 27;13:8109-8120. doi: 10.2147/CMAR.S334094. eCollection 2021.
We set out to explore the prognostic value of circulating lymphocyte subsets in patients with nasopharyngeal carcinoma (NPC) before treatment and to investigate changes in lymphocyte subsets resulting from chemoradiotherapy.
This retrospective study included 677 patients with non-metastatic NPC. The cutoff value of lymphocyte subsets was determined by the receiver operating characteristic curve (ROC), and the prognostic significance of lymphocyte subsets was evaluated by the Log rank test and Cox proportional hazards model. The endpoints were overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS). Differences in lymphocyte subsets before and after chemoradiotherapy were analyzed by Wilcoxon signed rank test.
NPC patients with high levels of CD19 B cells (>9.55%) had better 5-year OS (90.4% VS 76.8%, P < 0.001), 5-year PFS (85.3% VS 71.6%, P < 0.001) and 5-year DMFS (94% VS 86.8%, P = 0.002) than patients with low levels of CD19 B cells. Patients with high levels of CD4 T cells (> 37.05%) had better 5-year PFS (83% VS 74.2%, P = 0.015) and better 5-year DMFS (95.8% VS 86.7%, P < 0.001) than those with low levels of CD4 T cells. Multivariate analyses indicated that CD19 B cell was an independent prognostic factor for OS, PFS and DMFS in NPC. And CD4 T cell was an independent prognostic factor for PFS and DMFS. Within 1 month after chemoradiotherapy, the percentages of CD4 T cells, CD19 B cells, and the CD4/CD8 ratio decreased significantly, while the percentages of CD8 T cells increased significantly.
NPC patients with low levels of CD19 B cells or CD4 T cells before treatment have a poor prognosis. In addition, chemoradiotherapy may reduce the body's immune function in NPC patients.
我们旨在探讨鼻咽癌（NPC）患者治疗前循环淋巴细胞亚群的预后价值，并研究放化疗导致的淋巴细胞亚群变化。
这项回顾性研究纳入了677例非转移性NPC患者。通过受试者工作特征曲线（ROC）确定淋巴细胞亚群的临界值，并通过对数秩检验和Cox比例风险模型评估淋巴细胞亚群的预后意义。终点指标为总生存期（OS）、无进展生存期（PFS）、局部区域无复发生存期（LRFS）和远处转移无复发生存期（DMFS）。采用Wilcoxon符号秩检验分析放化疗前后淋巴细胞亚群的差异。
CD19 B细胞水平高（>9.55%）的NPC患者5年总生存期（90.4%对76.8%，P<0.001）、5年无进展生存期（85.3%对71.6%，P<0.001）和5年远处转移无复发生存期（94%对86.8%；P=0.002）均优于CD19 B细胞水平低的患者。CD4 T细胞水平高（>37.05%）的患者5年无进展生存期（83%对74.2%，P=0.015）和5年远处转移无复发生存期（95.8%对86.7%，P<0.001）均优于CD4 T细胞水平低的患者。多因素分析表明，CD19 B细胞是NPC患者总生存期、无进展生存期和远处转移无复发生存期的独立预后因素。CD4 T细胞是无进展生存期和远处转移无复发生存期的独立预后因素。放化疗后1个月内，CD4 T细胞、CD19 B细胞百分比及CD4/CD8比值显著下降，而CD8 T细胞百分比显著升高。
治疗前CD19 B细胞或CD4 T细胞水平低的NPC患者预后较差。此外，放化疗可能会降低NPC患者的机体免疫功能。
